Why Grab Bar Installation Is a DME Issue

Caretakers are generally very comfortable unboxing walkers, shower chairs and toilet rails and placing them within their patients’ reach. The product is needed, it’s ordered and the patient gets the assistance they need.

Grab bars are different.

While grab bars are simple to use once installed, their installation is often anything but simple. The effectiveness of the bar is completely reliant on the structure beneath the surface it’s mounted to and how well the mounting is done. Retrofitting a grab bar in an existing wall, particularly a tiled bathroom wall, requires specialized knowledge to determine what is behind a wall, expertise in drilling a variety of tile types, training in installing proprietary anchoring systems and the experience and skills to know how to install in less than ideal conditions.

In most homes, studs are rarely where they are needed and plumbing and electrical hazards lurk just below the surface. In older homes, years of DIY renovations can mean that electrical, plumbing, vents and other hazards are often run through the walls in unexpected places and orientations, making drilling particularly hazardous.

The risks and skills required to retrofit grab bars mean that professional contractors often decline the work because of concerns about cracking tile or encountering hidden hazards behind the wall.

A Gap in Training

In addition, grab bars have slipped through the cracks in terms of training for their installation. Despite the difficult nature of the work and the dire consequences of installation failure, grab bar installation is often treated as handyman-level work, and homeowners have no way to verify that the installer has been trained to install this critical piece of safety equipment correctly. The manufacturers offer some guidance, but unlike the plumbing and electrical trades, there is not a universally adopted training standard for grab bar installation.

This matters because a grab bar is not simply another piece of hardware in a bathroom. It is life-safety equipment intended to prevent serious injuries. Many outside the durable medical equipment (DME) industry may not realize the scale of bathroom fall injuries. A Centers for Disease Control analysis of 2008 emergency department data estimated that 234,094 nonfatal bathroom injuries were treated in U.S. emergency departments, with 81.1% caused by falls.

Before my current role running operations at the Grab Bar Installers Association of America (GBIAA), I had the privilege of working in the back office of a small, highly focused company that specialized in grab bar installation. We were always in high demand, and the most common refrain from grab bar customers was, “You have no idea how hard it was to find you. I’ve made so many calls, and everyone turned me down.” I was told over and over again about other contractors in our area who flat-out refused to take on grab bar work, citing liability and their lack of confidence in drilling through tile.

I also fielded calls from customers who’d bought their own grab bars, only to never install them—they didn’t have the right tools, weren’t sure how to drill tile, couldn’t figure out where the studs were, got busy or, in some cases, the family member who promised to do the install backed out. Whatever the reason, the grab bar never found its way onto the wall and sat in the box.

The calls that sent everyone’s blood pressure through the roof were the ones where the family reached out after a failure. Three times we had customers reach out saying that they had hired someone else to install grab bars, thinking that they were getting quality work done, only to have them rip right out of the wall when they were pulled on. Each time, our technicians reported back that the grab bars were installed with plastic drywall hangers appropriate for hanging a framed photo, not for supporting the weight of an adult in a moment of panic.

Installer Qualifications

A common misconception is that the difficult part of a grab bar installation is drilling through delicate, brittle tile. A professional knows that’s just one of many skilled steps, beginning long before the first hole is drilled

Grab bars are not a one-size-fits-all piece of safety equipment. A skilled installer will start with the end user in mind. They will ask the person to demonstrate how they move around their bathroom and ask questions about where the user expects to need support. Before moving forward, they will agree on placement, orientation and bar sizes based on the current and future use of the room.

Once the initial placement has been agreed on, the installer will use multiple methods to determine what’s behind the wall and the structural integrity of the mounting surfaces. When the ideal location doesn’t provide adequate structure, they need to consider multiple anchoring techniques and alternative approaches. All of this happens before the drill is even picked up.

My cofounder at GBIAA and technical advisor Emilio Baires worked for 20 years in the field and heard many of the same customer stories I did in the office, but he also heard them from the installer side. Baires’s experience with grab bar training was that it’s a skill often taught on the job or by trial and error. That leaves a lot of room for things to go wrong. Baires was in charge of training at our installation company, and many times had to re-train installers who had been taught bad practices—it wasn’t their fault, there just wasn’t a solid, standardized resource for them to learn from.

A lot of general construction knowledge is passed on this way, and in many cases it’s a great way to learn. However, learning to perform a complex, life-safety retrofit such as installing a grab bar needs more structure to gain true competence.

What This Means for DME Providers

It’s important to recognize when recommending grab bars that the installation is as important as the specifications of the bars themselves. DME professionals don’t need to learn how to install grab bars themselves. They do need to know what a proper installation requires and how to recognize a qualified installer. At the end of the day, a recommendation is only as good as the person carrying it out.

When helping a user select an installer, asking the right questions is key. Verify the experience and skill level of the installer by inquiring about the installs they have personally performed, how they go about selecting the placement locations of the bars, how they find and handle hidden hazards, how they decide what anchoring methods to use, and what they do if it turns out placement is not possible. Asking these questions will quickly expose the level of grab bar expertise an installer is bringing to the project.

What we need is a reliable way for homeowners, healthcare professionals and others making home modification recommendations to identify installers who have demonstrated that they understand the specific requirements of installing grab bars.

This is not to say that handymen don’t have their place. There are many skilled and competent generalists in the field doing valuable work every day. The important distinction is that general handyman and construction work is not the same thing as performing specialized safety-critical work, including grab bar installation.

The Grab Bar Installers Association of America has created a private training and credential specifically for grab-bar installation and is working toward national recognition of this credential.

Conclusion

At the end of the day, when a grab bar is recommended, the process should not falter because of an information vacuum and shortage of easily found, qualified installers.

A recommendation isn’t finished when it’s written on a report. It’s only finished when the grab bar is safely mounted on the wall and the user can rely on it when they need it.